The Burden of Diverticular Disease and Its Complications: West versus East

Abstract

Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs. Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk. Key Messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.

Acquired Diverticulosis of the Entire Colon in a Cadaver

“…This individual's diverticula were mostly localized to the ascending and transverse colon, which is consistent with diverticulosis in Asian and African populations [4,5]. Diverticular disease has an estimated genetic contribution of 40% to 53% [10].…”

“…Diverticulosis has been reported to occur in 42% of adults living in Western societies, with a left-sided predominance [2]. In Asia and Africa, diverticulosis is relatively rare, and when present, occurs chiefly in the right colon [4,5]. When it occurs in all three regions of the colon it is referred to as pancolonic [6], the prevalence of which is 7% in western culture [7].…”

Prevalence and Distribution of Colonic Diverticular Disease from Ordu in Turkey

“…With the increasing incidence of diverticular disease continues to be a burden in terms of health care costs in Western and Asian countries (Imaeda and Hibi, 2018). According to our predict that the incidence of diverticular disease will increase because of rising elderly population over the years in Turkey.…”

“…Diverticulosis is often seen in a population of 70 years old (Painter and Burkitt, 1975). Diverticular disease clinically has been classified into four types; symptomatic complicated by diverticulitis, diverticular bleeding, segmental colitis and symptomatic uncomplicated diverticulitis (Imaeda and Hibi, 2018). Diverticular disease is the cause of a very high gastrointestinal symptom-related hospital admission.…”

“…Its incidence has been shown to increase over time in both Western and Asian population (Nagata et al, 2014). This increase in the incidence of the disease will become a major of economic burden in terms of healthcare-costs (Imaeda and Hibi, 2018).…”